| NPI | 1457199002 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LISA PATERNOSTER Owner 208-244-6424 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2024-07-17 |
| Last Update Date | 2024-07-17 |